with Debra Lafler

Worksite wellness – Evolving back to wholeness

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What is worksite wellness? Some see it as providing health benefits, safety, and ergonomics. Others see it as “programs” like weight loss challenges, on-site fitness classes, or educational seminars. Still others see it as providing employees with financial incentives to do things related to health and wellness during the year. But is it more than those things? Yes!

According to the Centers for Disease Control and Prevention (CDC), “workplace health programs are a coordinated and comprehensive set of health promotion and protection strategies implemented at the worksite that includes programs, policies, benefits, environmental supports, and links to the surrounding community designed to encourage the health and safety of all employees.”

This definition is actually excellent, because it encompasses everything. Worksite wellness is not just a program that employees participate in; it’s a broader company value and strategy for caring for your employees. Truth be told, however, the worksite wellness field has been going through growing pains lately.

The beginning

Even though the wellness movement started in the 1970s (as we discussed last month), worksite wellness didn’t take off until the 1980s and had its start in corporate fitness. Through the 1990s the field expanded from fitness into health promotion and chronic disease prevention, and educated on things like heart health, nutrition, and tobacco cessation. The field also started developing ways to measure and track health status. To do this, employers did biometric screenings (measuring height, weight, blood pressure, cholesterol, and glucose) and health risk assessments (comprehensive health status and lifestyle behavior questionnaires that produce individualized and aggregate reports). These still go on today.

Also in the 1990s, the field moved from the concept of health promotion to that of holistic models of wellness. The National Wellness Institute’s Six Dimensions of Wellness is an example of a model that was widely used to cover physical, intellectual, emotional, spiritual, social, and occupational dimensions.

In 1987, the Wellness Council of America (WELCOA) was formed to offer resources and standards for employers who wanted to provide wellness programming for their employees. In 1997, WELCOA developed the industry’s first best practices. They called them Well Workplace, which had seven Cs (or steps of the process, each of which started with a C), and in 2000, renamed them “The Seven Benchmarks” and created manuals for employers to follow and apply for award rankings.

The original WELCOA Seven Benchmarks were:

Capture CEO and senior level support;

Create a cohesive wellness team;

Collect data;

Craft an operating plan;

Choose appropriate interventions;

Create a supportive environment; and

Carefully evaluate outcomes.

It basically was a strategic planning process that emphasized making your decisions based on data and doing evaluation at the end of the year to measure effectiveness. At the time, they called this a “results-based” program, meaning that you had goals that you wanted to meet, and at the end of the year you measured your results. As you can imagine, businesses gravitated toward this process.

Return on investment

Over the years though, especially with rising health care costs, the field — or the employers in the field — started looking at financials and return on investment (ROI). This actually became the major sales pitch at the time for why companies should engage employees in worksite wellness — that if you helped employees get healthier, your health care costs would go down. At first this seemed like a great idea, but proving it with adequate quantitative data soon became a major challenge for the field.

Companies that wanted to focus on financials and evaluate changes over time, in addition to biometrics and health risk assessments, started to collect: health care claims (both medical and mental health), pharmacy claims, workers compensation claims, disability claims (short-term and long-term), employee assistance program utilization rates, absenteeism rates, and turnover rates. (Note: these were all aggregate numbers, so no one’s private health information was shared.)

Some employers also started offering financial incentives — either cash, or discounts on health insurance — to employees to encourage them to participate in the data collection and/or programming. You’ve likely seen these types of programs. They look like checklists or points systems.

The controversial era

The next era is where the field started to get controversial. Even though a few employers may have been doing this in the ’90s or early 2000s, somewhere between the years of 2010–2015, employers increasingly started giving employees health standards to meet, like having your biometrics (weight, blood pressure, cholesterol, or glucose) in medically “recommended ranges.” The name for these became “outcomes-based” programs, meaning the person had to show a specific health status outcome or show improvement in order to get his or her incentive. Around this time, financial incentives also increased significantly.

Debates on this rippled through the field, flooding social media groups, posts, articles, blogs, webinars, and conferences. There were those who believed in the traditional methods of data collection, financial incentives, and possibly outcomes-based programs, and there were those who didn’t believe in any of it and wanted to pioneer a new frontier for the field. As with any debate, there were also those in the middle who wanted to keep some aspects of traditional approaches, but also wanted to broaden.

The new wellness — or well-being

Conversations over the last few years in the worksite wellness field have focused on our re-crafting our identity and intention. Who are we? What do we value? The most basic question — “What is wellness?” — even resurfaced. What seems to have won out is the idea that wellness is holistic — it’s not just physical, it’s all of the dimensions.

Some have suggested we change the name of the field from wellness to well-being because that helps move the concept away from just physical health. So, the next question was, “What is well-being?” Just like wellness, the term well-being has many different definitions. The most well known one is from Dr. Martin Seligman’s PERMA model — Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. The worksite wellness field has taken this to heart.

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About This Blog

Debra Lafler is a Madison-based wellness consultant, coach, and speaker with over 20 years of experience in the field. She currently works as the employee wellness and employee assistance program manager for the Wisconsin State Department of Health Services, and as an adjunct instructor for the University of Wisconsin’s Health and Wellness Management program. She also is available privately to hire as a business consultant, personal coach, or motivational speaker. Debra has a doctorate degree in Divinity & Spiritual Studies from Emerson Theological Institute; a master’s degree in Health & Behavior Studies specializing in Health Education from Columbia University; a bachelor’s degree in Communication, with certificates in Wellness and Coaching from The University of Wisconsin—Parkside; and certificates in Worksite Wellness, Holistic Stress Management, Grief Support, and Yoga. She can be reached at debra.lafler@wi.gov or deblafler@gmail.com.